Stroke treatment: think ‘fast’

People having an ischemic stroke should receive clot-dissolving therapy – if appropriate – within an hour of arriving at the hospital, according to new American Stroke Association guidelines published recently.

Ischemic stroke, which accounts for nine in 10 strokes, is caused by a blood clot in the arteries leading to the brain. Problems with clotting reportedly become more frequent as people age.

Calling for help immediately after recognising any of the warning signs of stroke – and getting to a stroke centre as fast as possible – are still the most important steps for optimal stroke care.

During an acute stroke, physicians must quickly evaluate and diagnose the patient as soon as possible to determine if patients are eligible to receive the clot-dissolving drug recombinant tissue plasminogen activator (tPA), which must be given 4.5 hours within hours of symptom onset.

Among other major revisions to the American guidelines, if feasible, patients should be rapidly transferred to the closest available certified primary care stroke centre or comprehensive stroke centre, which might involve air medical transport.

“However, for patients brought to hospitals without specialised stroke expertise, telemedicine can provide real-time access to expertise,” Edward Jauch, lead author of the guidelines, said.

Other key recommendations in the new guidelines include:

• Multidisciplinary quality improvement (QI) committees should be created within hospitals to review and monitor stroke care quality.
• Recently introduced stent retrievers could potentially remove large blood clots more completely and quickly than tPA. (But the devices shouldn’t be a substitute for intravenous tPA and should only be used in clinical studies to determine if they improve patient outcomes).

F.A.S.T. is an easy way to remember the sudden signs of a stroke:

Face drooping: Does one side of the face droop or is it numb?

Arm weakness: Is one arm weak or numb?

Speech difficulty: Is speech slurred, are you unable to speak, or are you hard to understand?

Time to call for help: If you have any of these symptoms, even if the symptoms go away, go to the hospital immediately.